Benefits of the Full Spectrum Approach

By Janna Blair Slack

I submitted the following essay to Midwifery Today for the Winter 2012 “Doula Issue.”  My friend, an editor at the publication, let me know they could not print it because it discusses elective termination, a subject they do not broach.  Midwifery Today has every right to its editorial decisions and perhaps this policy prevents unproductive flame wars amongst its subscribers.  Here is the original essay I submitted, discussing the growing full spectrum doula movement.

Benefits of the Full Spectrum Approach

copyright Janna Blair Slack

Full spectrum doulas support pregnant people regardless of the outcome of their pregnancy or their ability to pay.  This approach to doula work requires us to peer into the power structures of our society, discover places where insufficient support contributes to human suffering, and find avenues to provide that support.  To reach these places, we partner with institutions (i.e. hospitals, clinics, prisons), larger organizations (Planned Parenthood, community-based healthcare), and agencies (adoption, public health).

Since 2007, full spectrum groups have established themselves in at least fifteen states to support the spectrum of human pregnancy experience.  I am a full spectrum doula though I remain wary of the limiting potential of any title.  I knew I wanted to do this work before I signed up for my 2009 DONA birth doula training.  This is my description of this work from personal experience, as well as a vision for its future.  As increasing numbers of doulas are called to full spectrum work, the definition and potential of our profession will change for all of us.

Shedding assumptions, reaching out to connect

Emotionally sustainable full spectrum doula work is open, inclusive and non-judgmental.  The full spectrum approach tells us that everyone – from clients we support to staff and providers we work with – is really doing the best they can at any given moment.  Shedding assumptions provides a liberating feeling of openness and illuminates the emotional boundaries we navigate as birth workers.  I’ve become more aware of the important distinction between someone else’s journey and my own and therefore can more easily give unconditional support.

When I began to apply the full spectrum approach to my doula practice, I connected with more people from a wider range of life experiences.  I experience joy in connection so this was a serious bonus!  The first mother I supported through pregnancy termination taught me how positive this work can be.  A D&E (Dilation and Evacuation) takes a matter of minutes in the first trimester, but patients can spend hours waiting around, often completely alone.   She was sure of her decision but was anxious, crying and expressing feelings of guilt – someone had told her that according to the Bible, her toddler son would be “struck down” for what she was about to do.  She crumpled into my arms and cried.  I tried to be as present as possible and supplied her with tissues.  As we waited, she initiated conversation and eventually we were laughing and discussing the oeuvre of Kanye West.  During her procedure, I held her hands and her eyes with mine, whispering the same words I say during birth – “You can do it, deep breath, you can do it, nice and relaxed.”  Afterward, the woman I met a few hours earlier was gone and she moved confidently to gather her belongings and check out.  With a tight hug goodbye, she walked out the door with a smile on her face.  The nurses seemed thrilled at the difference in her demeanor.  I felt keyed up and soon realized I was experiencing the vibrant energy I normally associate with a “birth high.”

Some midwives and doulas feel it is macabre, even incongruous, to deal both in birth (associated with “life”) and non-birth outcomes (associated with “death,” or even “murder”).  Some worry how a broader outlook affects birth movement public relations and messaging.  All full spectrum doulas I know constantly work to give doulas a good name.  For many staff and providers we work with, full spectrum doulas are the first doulas they have heard of or worked with, and we feel the responsibility of representing the doula spirit of non-judgmental support as authentically as possible.

Providing doula employment

Bringing doula support to places it was previously unknown obligates most full spectrum doulas to work for free, proving our value to gain access.  We are dependent on volunteer energy, and the passion and dedication of our volunteers is tremendous.  Turnover and burnout are frustrating, persistent realities, but more and more we realize the unique opportunity we have created to become engines of employment in our field.  The organizations and institutions we partner with have access to funding about which an individual doula can only dream.  Doula support can often help achieve many healthcare and public health groups' goals for what amounts to a bargain.

The full spectrum approach must embrace a core tenet of financial compensation, accessed through our established partnerships, with as little headache and administrative cost as possible.  We don’t all need to become c-3’s to fundraise effectively.  Here are two examples of full spectrum organizations who have found ways to compensate their doulas: the first, partnered with a community healthcare organization in California, developed a relationship with a board member who made a gift which was nominal by the standards of western medicine but easily provides stipends for their doulas.  Portland’s Calyx Doulas are the second.  Partnered with an adoption agency, doula reimbursement will be a part of the birth-related expenses of birthparents, paid for by the adoptive families.

Surmounting socio-economic divisions in our network is crucial.  Insisting that our society’s money move toward the work that we do creates opportunities for more diverse populations to consider this as a profession.  This overarching goal complements and expands our vision.  Most of the full spectrum doulas I know come from some level of privilege and many women who want to do this work cannot for financial reasons.  We can all try to take responsibility to create opportunities for them and for all doulas seeking employment.

The endless conversation

As we feel our way into this new frontier and all it promises, we must treat ourselves with the same patience we try to provide each person we serve.  Our growth is dependent on continuous reexamination of what we do – asking ourselves how we achieve greater states of openness, compassion and inclusiveness.

If you are interested in learning more about the full spectrum approach, get your hands on a copy of The Radical Doula Guide: A political primer for full spectrum and childbirth support by Miriam Perez (published in August 2012).  “Radical” can be a scary word, but the Radical Doula Guide is not a manifesto, it’s “a starting point to understanding the social justice issues that interface with doula and birth activism.”  The RDG addresses these issues from a doula perspective, articulating philosophical aspects of the full spectrum approach.  I hope I didn’t lose you at “philosophical” because this Guide is truly readable and relatable for all of us!  I strongly encourage you to get your hands on a copy and join the conversation.

I feel especially conscious and respectful of opposing viewpoints within the birth community.  The full spectrum approach listens to, honors and learns from the concerns of our colleagues who may be opposed to our work.  As we pursue growth and expansion for all of us, your voice and thoughts on the matter are important.  If you have concerns or words of encouragement, full spectrum doulas are always open to conversation.  We are all responsible for the future of our field and for creating space for it in our culture.

Film Screening of Birth Story: Ina May Gaskin & The Farm followed by Q&A w/Shodhini Doulas

Film Screening of "Birth Story: Ina May Gaskin & The Farm" followed by Q&A w/Shodhini Doulas

Sunday, January 20, 2013
The Sacred Arts Center

5222 Hollywood Blvd, LA, CA 90027
$10-$15 (sliding scale)

This film tells the story of counterculture heroine Ina May Gaskin and her spirited friends, who began delivering each other's babies in 1970, on a caravan of hippie school buses, headed to a patch of rural Tennessee land. With Ina May as their leader, the women taught themselves midwifery from the ground up, and, with their families, founded an entirely communal, agricultural society called The Farm. They grew their own food, built their own houses, published their own books, and, as word of their social experiment spread, created a model of care for women and babies that changed a generation's approach to childbirth.

In the same spirit of women's self empowerment and self care the Shodhini Institute was created and has been working hard to spread their powerful message. The Shodhini Institute is a growing network of healers, bodyworkers, transmen, masculine of center womyn, doulas, midwives, nutritionists, yoginis, scholars and sheroes out to revolutionize the face of Western medicine regarding women's bodies, minds, and spirits.

Stay after the film screening to meet some of Shodhini's trained and experienced doulas. We will be hosting an open Q&A about birth work and their role as doulas. Spread the word!

Donations go to support The Shodhini Institute & The Sacred Arts Center

For more information:

Facebook Event 

shodhini.blogspot.com

www.shamansvision.org

Woman-Centered Pregnancy and Birth - Chapter 2

Excerpt from Chapter 2 of Woman-Centered Pregnancy and Birth by Ginny Cassidy-Brinn, R.N., Francie Hornstein, and Carol Downer
Federation of Feminist Women's Health Centers
Illustrations by Suzann Gage

Full Book AVAILABLE online for FREE

PDF of Chapter 2: Available ONLINE for FREE

Chapter 2: First, You Have To Get Pregnant

 

SIGNS OF PREGNANCY

Subjective Signs

Many women experience

• Breast tenderness
• Nausea
• Fatigue or sleepiness

Some women experience

• Breast enlargement
• More frequent urination
• Weight gain
• Sensitivity to certain tastes or odors
• Cravings for or ability to eat only certain foods
• Changes in the appetite

Uterine Signs

• Missed menstrual period (for most women)
• Softer uterus
• Enlargement of the uterus

7 weeks of pregnancy - the size of a lemon

9 weeks of pregnancy - the size of an orange

12 weeks of pregnancy - the size of a grapefruit

Cervical Signs

• Change of color to a deeper red or bluish-purplish
• Softer cervix
• The os is more open than usual

 

Cervical Examination

    Looking at the cervix provides valuable information in pregnancy detection and is usually included as part of an examination by a physician or health worker.  It is even more useful for a woman to look at her own cervix if she has done self-examination before and is familiar with the appearance of her cervix when she is not pregnant.  Many women notice changes in their cervices by comparing what they see to the way it usually looks.  A darkening in color to a deeper red or bluish-purplish color is characteristic of pregnancy.  This is caused by the increased blood supply to the cervix and uterus.  This color change can occur within days after conception or, in some women, it doesn't become apparent until she is several months pregnant.  When a woman is several weeks pregnant, the cervix is softer and the os is more open than usual. 

Uterine Size Check

    Feeling an increase in the size of the uterus can be another indicator of pregnancy.  Since it is very difficult for a woman to feel her own uterus, this examination is usually done by a friend in a Self-Help group, a health worker or a physician.  A uterine size check or pelvic examination provides more specific information about the length of a pregnancy than looking at the cervix or a chemical pregnancy test does.  And experienced examiner will be able to tell with reasonable accuracy (within one to two weeks), how many weeks pregnant a woman is by the size of her uterus.  For example, the uterus is about the size of a large, unshelled walnut or a plum if a woman is not pregnant.  The uterus of a woman who is about seven weeks pregnant is about the size of a lemon; nine weeks, the size of an orange; and 12 weeks about the size of a grapefruit. Making the comparison of uterine size to fruit sizes is helpful for training women in Self-Help Clinics, health workers and physicians.  It is also valuable for graphically explaining to women about the increase in uterine size in early pregnancy. 

    If a woman has participated in a Self-Help group together to feel the size of her uterus and report if it feels softer or larger than it previously did.

    The length of time since the union of sperm and egg is usually measured from the first day of a woman's last menstrual period.  This is done for uniformity since many women do not know exactly when they became pregnant.  In fact, even when women know the exact date that they became pregnant, physicians still measure Gestation from the first day of the last normal menstrual period (LNPM).  The actual size of a woman's uterus is used less often by physicians.

    Any one subjective sign or observable characteristic of a woman's cervix and uterus is usually not enough for her to conclude that she is pregnant.  More often, it is a combination of these factors together with the knowledge that she was exposed to sperm at a time in her cycle when it was likely that she had ovulated.  However, some women have such regular menstrual periods that a matter of a few days of delay of their periods signals a sure sign of pregnancy to them.

    There are situations in which women find it difficult to determine whether or not they are pregnant.  Women who have irregular periods, who are under great stress, women who are nearing menopause, women who have recently stopped taking the Pill, or women who have signs of pregnancy often have difficulty in determining pregnancy without the help of a chemical test.  Occasionally, a woman has some bleeding around the time of her expected period when she is actually in the early part of her pregnancy.  Many a woman mistakes this for her regular period, especially if she has no other indication that she is pregnant.  Usually, this bleeding is different from a normal period; sometimes there is a lighter flow or the flow does not last as long as a regular period.  Also, having these episodes of bleeding can cause women or their physicians to think they have not been pregnant as long as they have been.  In these instances, having a uterine size check is particularly important. 

Woman-Centered Pregnancy and Birth - Chapter 2

Excerpt from Chapter 2 of Woman-Centered Pregnancy and Birth by Ginny Cassidy-Brinn, R.N., Francie Hornstein, and Carol Downer
Federation of Feminist Women's Health Centers
Illustrations by Suzann Gage

Full Book AVAILABLE online for FREE

PDF of Chapter 2: Available ONLINE for FREE

Chapter 2: First, You Have To Get Pregnant

 

Determination of Pregnancy 

 

Many women are able to determine pregnancy in themselves without the aid of a health worker, physician, or any chemical tests for pregnancy.  Even women who are quite sure often visit a clinic or physician for confirmation, but it is not uncommon for women to feel that the test is only a formality since they are certain that they are pregnant.  Diagnosis of pregnancy is, after all, nothing more than a conclusion based on taking note of a woman's history and any physical sign and changes she has, sometimes with the aid of a chemical pregnancy test.

Traditionally, physicians rely on objective measurements such as feeling the size of the uterus, using chemical pregnancy tests or listening to the fetal heartbeat.  Brigitte Jordan, in an article entitled "The Self-Diagnosis of Early Pregnancy: An Investigation of Lay Competence," (1) has documented the value of women using subjective signs to determine pregnancy.  Out of 28 women in Jordan's study, none of whom had any objective (medically acceptable) evidence that they were pregnant, nearly one-half knew they were pregnant before they had missed a period and 44% were convinced that they were pregnant before the time when a commonly used urine pregnancy test would have been accurate.  All were correct except one woman who turned out to be getting injections of human chorionic gonadotropin (hCG) for weight reduction and had feelings of pregnancy from the drug.  Jordan believes, "It can be concluded that the women in this sample were able to make a diagnosis of pregnancy earlier and with greater accuracy than is possible in a physician's office."

Making a determination of pregnancy can be more or less difficult, depending on whether a woman has any changes in how she feels of the way her body looks; or whether or not she has been pregnant before; or whether or not she menstruates regularly.  The likelihood of pregnancy depends on at what point in a woman's cycle she was exposed to sperm and whether or not she was using birth control at the times.

Some women notice subjective signs within a short time after becoming pregnant.  These signs are extremely valuable in determining pregnancy, both for the woman herself, and for her health worker or physician.  The signs are many and varied and a woman may have all, some or none of them.  Health workers have reported that the most common signs experienced by women in early pregnancy are breast tenderness, nausea, and fatigue.  Other subjective signs of pregnancy described by women include breast enlargement, frequent urination, weight gain, sensitivity to certain tastes or odors, and cravings for or ability to eat only certain foods.  Also, some women have noticed changes in their appetites, finding that they eat more or less food than usual.

Looking back, the first sign of pregnancy I had was when I fainted at the office.  I attributed the fainting to not having eaten breakfast and then eating a sweet pastry and drinking coffee.  Later I noticed I gagged if I walked into a room where someone was drinking coffee.  I spent a Sunday making vichyssoise and when I brought it to the table and lifted my spoon out of the bowl, I had to leave.  At this point I knew none of this was psychological.  My breasts, which are quite small, grew more than I ever thought possible.  So it was no surprise when I didn't get my period on schedule.  I estimate that I started getting signs of pregnancy about a week to ten days after getting pregnant.

BIRTH - HELP GET THIS DOCUMENTARY ON PBS!

TO DONATE: http://www.indiegogo.com/birth?c=home

BIRTH Trailer

BIRTH is a brand new documentary feature film by award-winning filmmaker Christopher Carson and best-selling childbirth author/teacher Suzanne Arms. This film is narrated by actress Carrie-Anne Moss, the mother of three children.

BIRTH features interviews with some of the most notable and leading edge practitioners, researchers and educators in the fields of pregnancy, childbirth, maternal-newborn care, women's health, breastfeeding, birth trauma, brain science and obstetric and neonatal practices.

BIRTH examines the midwifery model of childbirth and the medical obstetrical model of childbirth and compares the two models for levels of safety, cost, quality of care as well as immediate and long-term effects on our children and our families.

BIRTH features interviews and footage of mothers who have had a wide variety of birth experiences in hospitals, in birth centers, and their homes.  It also includes births in water, birth in the squatting position and even a birth in the ocean.

Suzanne Arms: "...Whatever amount you give makes you part of this ground-breaking hard-hitting show to transform how we bring babies into the world and care for each birthing woman."